| NPI | 1821382201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 270502) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32010) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2024-03-10 |